Online Journal of Rural Nursing and Health Care, 1(1) 6 

Editorial 

Rural Practice Forum:  Understanding Rural Health Care 

Bette Ide, PhD, RN, Editorial Board Member 

 

 This column will deal with how the rural health professional actually practices.  As a 

health care provider living in a rural community, how do you deal with the characteristics of 

rural people, cultures and communities on an everyday basis?  The literature has emphasized 

certain characteristics of rural people and communities that influence the role of rural health 

professionals.  They include factors such as a present time/crisis orientation, emphases upon 

individualism and independence, reliance upon self-care for health problems, and a tendency to 

tough-it-out.  Health is often defined by rural people as the ability to work.  Also impacting the 

role of the health professional is the strong role of opinion leaders, those few influential people 

or families in the community who control the degree to which people and ideas are accepted.  

The rural community often acts as gatekeeper, conferring status and acceptance of ideas, thus 

preferential treatment is common and insider/outsider distinctions are often made.  Rural people 

tend to be conservative and tradition-oriented, family and friends are very important, and the 

rural health professional is part of the social support network (often being seen as a friend first 

and a professional second).  In addition, the rural health professional often deals with populations 

with greater proportions of the dependent and vulnerable, high rates of risk taking behaviors, and 

differences in how mental health problems are viewed and interpreted. 

 As a health care provider, the rural health professional often crosses over other 

disciplines in role, is overwhelmingly a generalist, practices independently to a degree unknown 

by urban health professionals, and encounters frequent gaps in health care, especially the in the 



 

Online Journal of Rural Nursing and Health Care, 1(1) 7 

areas of primary care, health promotion, emergency care, and mental health services.  Physical 

and professional isolation are counter-balanced by a lack of anonymity and a mixing of 

professional and everyday roles.  The health professional is expected to be available on a 24-hour 

basis, sometimes giving professional advice while standing in line at the local grocery, and may 

have to leave town to get a day off.  In providing health care, the rural health professional must 

also deal with situations where the health professional’s values conflict with those of the 

community.  This offers a lot of opportunity for ingenuity and innovation in designing and 

carrying out programs that are acceptable to the rural community. 

 This column asks how you, as a rural health professional, have dealt with, taken 

advantage of, and risen above problems or issues such as the foregoing.  What ways have you 

developed to deal with them in your everyday practice?  In planning and carrying out programs?  

We can learn from each other.  We are interested in your "ingenuity and innovation."  What 

"tips" can you offer to other rural health professionals?  Please send a description of the problem 

or problems you have encountered in practice and how you dealt with those problems by e-mail 

to: Bette_ide@mail.und.nodak.edu.